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virtual dermatology tackles backlog and access barriers in canada
5 minute read
with dermcafé, a patient is virtually matched with a dermatologist in their home province, except for manitoba which currently has no dermatologists in practice.
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jennifer moore had ongoing dry, chapped and peeling lips that got so bad she was drinking her coffee with a straw until she finally gave up coffee altogether.
at first she thought the problem might solve itself, but time didn’t heal and it began to chip away at her self-confidence.
“it started in november, in the wintertime, so definitely i was thinking maybe it’s just something that’s going to go away,” says moore, a 30-year-old from cornwall, ont. “but clearly that wasn’t the case here. it didn’t go away, so i started getting concerned. it’s obviously not comfortable and it’s made me self-conscious constantly having dry lips, and i started throwing out lipsticks and things like that because i was so concerned thinking that was the cause.”
she went from trying different lip balms and moisturizers to petroleum jelly, and trying to prevent getting her saliva on her lips, thinking it might be a cause. she also wondered if she had developed an allergy to coffee or if it was dehydrating the skin of her lips. like many canadians, moore doesn’t have a family doctor, but she does have a nurse practitioner. the clinic office advised her to first see a pharmacist, which she did, and was told the dryness should have cleared on its own and to go to her nurse practitioner. her appointment was almost a month away, so she started looking online for a dermatologist.
she landed on dermcafé, a platform that is leading virtual dermatology care in canada. the first digital health model of its kind for dermatology, the portal allows patients to connect with a board-certified dermatologist in under a week without paying out of pocket, using their provincial health card. the platform is reportedly the only digital dermatology service in canada that takes public insurance.
patients submit photos of their skin, hair or nail concern. they have a brief triage appointment and then within a week they are seen virtually by a dermatologist who has reviewed their photos and is able to diagnose the problem and create a personalized treatment plan.
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moore was able to get the online triage appointment and then see the dermatologist quicker than her appointment with her nurse practitioner.
“i thought the whole process was really straightforward and the best part is no wait times or travel,” she says, adding finding care for her children would have been difficult, along with waiting to see a dermatologist more than an hour away in ottawa. she has a specially mixed topical cream to treat her cheilitis, a relatively common inflammatory condition that comes from irritants, allergies or an infection, or even habitual behaviours like lip-licking.
“they didn’t say i can’t drink coffee, so i’m definitely back to drinking it,” she says. she’ll be picking up the prescribed medication at her local pharmacy this week to start the daily topical treatment.
fewer than 700 dermatologists serving the entire country
in canada, seeing a dermatologist can take months because of the shortage of specialists. there are fewer than 700 dermatologists serving the entire country, so many people are left waiting for care, often while their conditions worsen. dr. annie liu, co-founder of dermcafé, started her practice in toronto after graduation, but found the limitations of the health system in canada worked against her and people who were looking for help.
“dermatology care is very much in a crisis,” she says. “i tried to do regular dermatology [in a clinic], and i felt like i was letting people down every day.” she knows how important appearance is for people and how it impacts their lives.
she says that barriers to care are an indignity for people waiting for months to get help for something they’re worried about that’s affecting their day-to-day.
“our skin is our biggest organ, so it’s alive. it reacts to how we feel, how we’re doing medically, and it’s very much a window into our health and our mental health. if a woman is experiencing a new mole during pregnancy, definitely they should see a doctor as soon as possible and in canada that concept is kind of a joke. you won’t be able to see a dermatologist for a year or more, after you get the referral.”
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she emphasizes that while you should get a professional diagnosis and treatment for any skin, hair or nail abnormalities, that’s not very realistic in canada. a lot of cities do not even have a dermatologist.
liu and a few software engineers started building the platform in january 2020, right before the pandemic, and launched that may, gaining immediate and lasting pickup of patients. the approach not only tackles the backlog, but expanded access to care is also transforming the patient experience for people liu has treated, like busy working parents, truck drivers with demanding schedules, and individuals with social anxiety that can now comfortably access dermatology care from anywhere.
now there’s a team of 40, treating the most common conditions, including acne, hair loss, facial rash, pediatric concerns, that can be corrected with topical products or tablets. research shows that 80 to 90 per cent of skin concerns can be safely addressed through virtual care, with medical outcomes comparable to in-person visits.
people with more complex issues that require surgery or injectables can’t be accommodated.
patient-focused skin care is top priority
the goal is to provide accessible, affordable and effective service, and make the patient experience as simple as meeting someone for coffee at a cafe (hence the name), liu explains. a patient is matched with a dermatologist in their home province, except for manitoba which currently has no dermatologists in practice. for these patients, a dermatologist on liu’s team consults with a primary care provider in manitoba to develop a treatment plan.
the model of teledermatology is not supported by some dermatologists in canada, however, with “senior physicians” openly criticizing the concept as “inappropriate.”
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“i think it’s because the medical community in canada is very conservative and this kind of initiative is very different from the status quo,” says liu. “when there’s such a crisis and there’s a way to help patients and do it safely and integrate some modern technology into healthcare, i think it’s a good thing.” she also points out that dermatologists diagnose conditions based on visual inspection, which is how dermatology is taught in medical school.
“that’s how i was examined on my final exam through photos and everything that we care for on dermcafé does not require in-person, procedures or up-close inspections. it’s more so about talking to the patient about the plan and choosing a medication,” she says. “it’s meant to be hassle-free and even enjoyable.”
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